How ACA and Revised BCRA Premiums and Deductibles Differ within and among States

Click on or select a state to access a fact sheet exploring the coverage implications.

 

We compare the premiums plus deductibles an example consumer would face under the ACA and revised BCRA in 2020. BCRA would significantly broaden age rating in the nongroup market and would reduce premium tax credits for older adults compared with the ACA, so we use a single 60-year-old adult at four income levels as our example to demonstrate the implications of those changes. We present data for each premium rating area in selected states. 

Each fact sheet has a table that lists annual premiums plus deductibles, as well as premiums plus deductibles as a share of income, for our example person in each of that state’s premium rating areas. A second table lists which counties are included in each state rating area.

We base 2020 premiums and deductibles on the second-lowest-cost Marketplace premium in each rating area in 2017 (inflated for three years of premium and deductible growth), using bronze (60 percent actuarial value) for the BCRA option and silver (70 percent actuarial value) for the ACA. Lower–actuarial value plans have higher out-of-pocket cost requirements (deductibles, co-payments, co-insurance, out-of-pocket maximums) than higher–actuarial value plans. BCRA would tie its premium tax credits to a 58 percent actuarial value plan (which could go as low as 54 percent due to permissible variation) whereas an ACA bronze plan has a 60 percent (+/- 2 percent) actuarial value; still, the bronze ACA plan is a reasonable proxy for analytic purposes. In reality, the BCRA premium would be somewhat lower than the bronze ACA premium, but BCRA cost-sharing requirements would be somewhat higher. In each rating region, we select the premium and the corresponding deductible for standard coverage (either 60 percent of 70 percent actuarial value, depending on the scenario) or the ACA cost-sharing reduction plan deductible where appropriate. We assume 3:1 age rating under the ACA and 5:1 under BCRA. Under BCRA, the ACA's cost-sharing reductions are eliminated. We assume that states would eliminate their Medicaid-expansion programs under BCRA because of the reduced federal matching rate but most of the people losing Medicaid eligibility would be eligible for the bill's nongroup premium tax credits.